The long term objective of Cedars-Sinai Medical Center program is to reduce morbidity and mortality in ischemic heart disease through improved diagnosis and therapy. Cedars-Sinai is unique in that it is the only community hospital awarded SCOR-IHD grant in the fifteen year history of the NIH program, reflecting its unique capability to bridge the critical gap between scientific innovations and their effective implementation in clinical medicine. This SCOR-IHD renewal consists of 13 units. As in previous programs it emphasizes critical new research directions that have high potential for substantially improving the diagnosis and treatment of coronary disease in the next five years but are not yet ready for clinical implementation. The programs include: 1. Development of new thrombolytic therapies for acute myocardial infarction. 2. Development of new tomographic imaging techniques for improving information extraction in nuclear scintigraphy. 3. Development of new two dimensional echocardiographic images of the distribution of micro-bubbles, as a means for assessing organ perfusion. 4. Development of new digital angiographic methods for visualizing and quantifying regional myocardial perfusion and coronary anatomy. 5. Development of methods for intravascular visualization of coronary stenoses, and their ablation by laser energy. 6. Development of new mor sensitive and specific biochemical markers for ischemia using emerging immunohistochemical monoclonal antibody techniques. 7. Development of coronary sinus retroperfusion as a new method for myocardial support during bypass surgery, percutaneous angioplasty and intravascular laser surgery. In these and other studies, Cedars-Sinai is also distinguishable, although not unique in our application of strong biometric control in all aspects of research from study design, through peer review of preliminary results, to analysis of the incremental information and cost-effectiveness of new tests, to find presentation of results in scientific meetings and peer-review journal.